来那度胺联合地塞米松与硼替佐米联合地塞米松治疗初诊多发性骨髓瘤且适合移植的患者的疗效比较。
Cyclophosphamide-bortezomib-dexamethasone compared with bortezomib-dexamethasone in transplantation-eligible patients with newly diagnosed multiple myeloma.
机构信息
Division of Hematology, The Ottawa Hospital, Ottawa, ON.
School of Epidemiology, Public Health and Preventive Medicine, The Ottawa Hospital Research Institute, Ottawa, ON.
出版信息
Curr Oncol. 2020 Apr;27(2):e81-e85. doi: 10.3747/co.27.5385. Epub 2020 May 1.
INTRODUCTION
Cyclophosphamide-bortezomib-dexamethasone (CyBorD) is considered a standard induction regimen for transplant-eligible patients with newly diagnosed multiple myeloma (mm). It has not been prospectively compared with bortezomib-dexamethasone (Bor-Dex). We aimed to compare the efficacy of CyBorD and Bor-Dex induction in transplant-eligible patients.
METHODS
In a retrospective observational study at a single tertiary centre, all patients with transplant-eligible mm who received induction with CyBorD or Bor-Dex between March 2008 and April 2016 were enrolled. Progression-free survival (pfs), response, and stem-cell collection for a first autologous stem-cell transplantation (ahsct) were compared.
RESULTS
Of 155 patients enrolled, 78 (50.3%) had received CyBorD, and 77 (49.7%), Bor-Dex. The patients in the Bor-Dex cohort were younger than those in the CyBorD cohort (median: 57 years vs. 62 years; = 0.0002) and more likely to have had treatment held, reduced, or discontinued (26% vs. 14.5%, = 0.11). The stem-cell mobilization regimen for both cohorts was predominantly cyclophosphamide and granulocyte colony-stimulating factor (gcsf). Plerixafor was used more often for the CyBorD cohort ( = 0.009), and more collection failures occurred in the CyBorD cohort ( = 0.08). In patients receiving Bor-Dex, more cells were collected (9.9×10 cells/kg vs. 7.7×10cells/kg, = 0.007). At day +100, a very good partial response or better was achieved in 75% of the CyBorD cohort and in 73% of the Bor-Dex cohort ( = 0.77). Median pfs was 3.2 years in the Bor-Dex cohort and 3.7 years in the CyBorD cohort ( = 0.56).
CONCLUSIONS
Overall efficacy was similar in our patients receiving CyBorD and Bor-Dex. After ahsct, no difference in depth of response or pfs was observed. Cyclophosphamide-gcsf seems to increase collection failures and hospitalizations in patients receiving CyBorD. Prospective studies are required to examine that relationship.
简介
环磷酰胺-硼替佐米-地塞米松（CyBorD）被认为是适合移植的新诊断多发性骨髓瘤（mm）患者的标准诱导方案。它尚未与硼替佐米-地塞米松（Bor-Dex）进行前瞻性比较。我们旨在比较 CyBorD 和 Bor-Dex 在适合移植的患者中的诱导效果。
方法
在单一三级中心的回顾性观察性研究中，招募了 2008 年 3 月至 2016 年 4 月期间接受 CyBorD 或 Bor-Dex 诱导治疗的所有适合移植的 mm 患者。比较无进展生存期（pfs）、反应和第一次自体干细胞移植（ahsct）的干细胞采集。
结果
在 155 名入组患者中，78 名（50.3%）接受了 CyBorD，77 名（49.7%）接受了 Bor-Dex。Bor-Dex 队列的患者比 CyBorD 队列的患者年轻（中位数：57 岁比 62 岁；=0.0002），更有可能停止、减少或中断治疗（26%比 14.5%，=0.11）。两个队列的干细胞动员方案均主要为环磷酰胺和粒细胞集落刺激因子（gcsf）。CyBorD 队列更常使用普乐沙福（=0.009），CyBorD 队列的采集失败更多（=0.08）。在接受 Bor-Dex 的患者中，采集的细胞更多（9.9×10 个细胞/kg 比 7.7×10 个细胞/kg，=0.007）。在第+100 天，CyBorD 队列中 75%的患者和 Bor-Dex 队列中 73%的患者达到了非常好的部分缓解或更好（=0.77）。Bor-Dex 队列的中位 pfs 为 3.2 年，CyBorD 队列为 3.7 年（=0.56）。
结论
在接受 CyBorD 和 Bor-Dex 的患者中，总体疗效相似。在 ahsct 后，观察到反应深度和无进展生存期无差异。在接受 CyBorD 的患者中，环磷酰胺-gcsf 似乎会增加采集失败和住院治疗的风险。需要前瞻性研究来检验这种关系。
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